PBSI-EHR Off the Charts!

PBSI-EHR Off the Charts! Enhancement Release 3.2.1 TABLE OF CONTENTS Description of enhancement change Page Encounter 2 Patient Chart 3 Meds/Allergies/Problems 4 Faxing 4 ICD 10 Posting Overview 5 Master ICD10 Code Book 6 Understanding the Instructional Notations 6 Understanding the Organizations of ICD10 codes 8 General Equivalence Mapping (GEM) 10 Build your own ICD9 to ICD19 mapping tables for commonly used codes 11 Using the Mapping Table 12 Mass Add 13 Adding codes to Superbill Templates 14 Changes to Superbill Posting 15 Problem List Modifications: 17 Selecting the SNOMED CT 19 ICD10 Default Settings in Practice File Maintenance 20 Posting your Diagnosis codes 21 Post using ICD9s with NO Pre-mapping to ICD10 22 Post using ICD9 to ICD10 Mapping Table 25 Posting Additional ICD10 codes from the NOTES instructions 26 Batch Proof with ICD10 28 E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 1 of 28

ENCOUNTER Provider Progress Note: Access is now available to all employees to view or print the Provider Progress Note. The Provider Progress Note can be set up in File Maintenance and gives the Provider the ability to modify what information is printed and selection of the order. The Provider Progress Note is an alternative option to send to a Referring Provider when a letter is not necessary or ease of reading today s progress note for the Provider, with content displayed as per their designed report. Comments entered on an order item will print on the progress note. Encounter Letters: To allow easier access to letter recipients, all patient address book entries will be listed in the outbound letter entry screen. Encounter Dictation Box: Access to history of past dictations is available for selection into today s encounter dictation box. From the dictation panel click HISTORY. Click on the date of service to view and use SELECT to copy into today s dictation panel. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 2 of 28

PATIENT CHART Medical Records: Growth Chart has been added as an option for printing and faxing from the Print Chart button. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 3 of 28

MEDS / ALLERGIES / PROBLEMS Allergies: Description of allergy reaction and severity is displayed on Meds/Allergies/Problem screen. FAXING Outbound Fax Search New function available to search the outbound fax history by fax number From Outbound Faxes, select History, Search Faxes. Ennter Phone number and Search. SUPERBILL Chronic problem indicator If selected diagnosis codes on today s superbill are already part of the patient problem list the CRN check box will be highlighted in yellow. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 4 of 28

ICD10 POSTING OVERVIEW Post what you know, either ICD9 or ICD10. PBSI will provide mapping and/or selections for your specific choices. Post your ICD9 codes and PBSI will map it to your ICD10 code choices. Use your ICD9 code experience to find your ICD10 codes. Use your current and familiar code selection screen. Current templates of ICD9 codes may be used. PBSI can work with your practice to determine your top 30-50 ICD9 codes and create a template of those commonly used codes to quickly map to ICD10 coding. OR Post your ICD10 codes now and PBSI will map it back to your ICD9 codes! Navigate through the ICD10 Master codes by categories Search the ICD10 codes by code or descriptions Build a template of your commonly used ICD10 s Or do a mix of ICD9 and ICD10 posting. We capture BOTH codes! Make sure you follow the ICD10 posting rules! Coding notes and instruction notes are indicated when you view or select your ICD10 and can be displayed by clicking on the note indicators. You will also see a + sign alongside your ICD10 if an additional code is required! These are the coding notes published with the ICD10 coding books. There is also a glossary of TERMS available where notes are displayed for quick reference. Easy management of your DX coding provides for proper sequencing of your ICD10 codes where that is significant. Select codes from: Patient s problem list Today s exam codes Significant Family History of Problems New problems selected from Common codes Search of ICD10 code master Selected Diagnosis list will display BOTH your ICD9 and associated ICD10 with coding note indicators. Click the MAINTENANCE button to view the DX posting group and modify, sequence or add additional codes as needed. Diagnosis Codes and Levels of Specificity I-9 and I-10 Code Sets Compared: Code Length and Set Size ICD-9-CM 3-5 Numeric +V and E codes ~14,500 codes ICD-10-CM 3-7 Alphanumeric ~70,000 codes E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 5 of 28

MASTER ICD10 CODE BOOK Understanding the instructional notations Instructional Notations are published with the ICD10 Master Book. This page describes the terminology that is used within ICD10 Code Notes that you will see throughout the system. Instructional Notations contain important information about how your coding should be done. You should become familiar with these terms and their meaning. Pay particular attention to the Code First/Use Additional Code notes and the CODE ALSO notes. You must post a second ICD10 code along with the code to which this note is attached. The notes also indicate sequencing requirements for your additional codes. PBSI provides a NOTE indicator when one is present for the code you are viewing or have selected. If the indicator contains a + symbol, then the note contains additional coding requirements. codefirst: You will need to post a specific code from one of these groups first TERMS button will display the screen above for quick reference E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 6 of 28

Examples of ICD10 codes with NOTE indications: In this case, you must provide one of the additional codes as described in the note text. Also notice the parent Code s note: This note does not contain requirements for an additional code, but provides additional info. In the case below, for every ICD10 code in this family of codes (E08), you must post additional codes in the sequences described in the note text. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 7 of 28

Understanding the Organization of ICD10 codes ICD10 codes are organized into Chapters or Classifications as shown below. ICD10 Master buttons provide access to your ICD10 master book throughout the system. Click on the Chapter to View the Instructional Notations in the Text box at the bottom of screen. Double Click on the Chapter or highlight and SELECT to drill down into the Chapter s code groups. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 8 of 28

The + in front of an ICD10 code group indicates that there are ICD10 codes under this grouping. This is also called a FAMILY Click once on the code to open the FAMILY of codes. YELLOW highlighted codes are acceptable billing codes NOTES further define what this code or group represents. It also contains important coding instructions. To SELECT your ICD10 code: highlight and click SELECT The selected ICD10 code will be posted to the screen you are using. In this example we see the ICD10 listed in the DX Search screen. o The Indicator to the left of your ICD10 code contains a + which indicates that we need to post an additional code o PBSI will attempt to map your ICD10 code to its ICD9 equivalent. (this is covered in the posting examples section) o To delete or update, click MAINTENANCE. (this is covered in the posting examples sections) E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 9 of 28

General Equivalence Mapping (GEM) PBSI utilizes several General Equivalence Mapping (GEM) tables throughout the EHR. These tables are provided by CMS and US National Library of Medicine (UMLS). You may find these tables and utilization guides on the CMS website. The GEM tables provide mapping (to the extent possible): ICD9 to ICD10 ICD10 to ICD9 The results can be a one ICD9 to one ICD10 or can be a multiple ICD9 to a multiple ICD10 relationship. PBSI uses these tables to make it possible to quickly find mapped codes and to verify code relationships while we are required to post both the ICD9 and ICD10 codes. Here is an example of posting an ICD9 that GEM maps to its ICD10. (click SELECT and both the ICD9 and ICD10 are posted!) The GEM ICD9 380.4 was mapped to ICD10 H61.23 Very often, you must be more specific than the mapped ICD10 provides. To view the other ICD10 codes in this FAMILY of codes, click on the SHOW FAMILY button. You may now SELECT your more specific code from the detail list of codes. Be sure to read the NOTES to see additional coding requirements. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 10 of 28

Build your own ICD9 to ICD10 mapping tables for commonly used codes. Custom mapping can be pre-defined for quick posting of all 3 ICD9, ICD10 and SNOMED-CT. For a given ICD9, you can have one or many ICD10/SNOMED combinations. You can manually add an entry to the table. From your menu use the Custom ICD9 Mapping option. You can also add mapping table entries as you do your daily posting when a new combination is detected. The system will ask: do you want this (screen will display the ICD9/ICD10/SNOMED) added to the Mapping Table? To create a mapping table entry: Add your ICD9 code. Recommend that you add your ICD10 first o Click the ARROW for the ICD10 to get the GEM match or manually enter your number. o Click on the resulting ICD10 to view the family of all the codes for your selection Now add your SNOMED-CT code by looking at those related to your ICD10 o Click SNOMED w /ICD10 to view the possible SNOMED matches. If you will use this Mapping table combination EVERY TIME you post this ICD9, you may set the DEFAULT flag. This will select these codes each time you post this ICD9. Be very cautious with this setting. It should be rarely utilized. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 11 of 28

Using the mapping table: When you select an ICD9 from your DX selection screen, the mapping table entries will be displayed for quick selection. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 12 of 28

Build your own ICD9 to ICD10 mapping tables for commonly used codes. - Using Mass ADD To select multiple ICD10 from the ICD10 book into your mapping table: Use the ICD9 to ICD10 mapping Table Option: Enter your ICD9 code into the search criteria and SEARCH If matches already exist, they will be listed Click [Add Mass] The system will use the GEM (General Equivalence mapping) to find the matching ICD10. Click [Show Family] to view all of the related ICD10s Click on the SEL box for each ICD10 that you want to map to this ICD9 Click [Select] E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 13 of 28

Adding ICD9 Mapped Codes to Supebill Category Templates: From File Maintenance select SUPERBILL SYSTEM DIAGNOSIS 1. Click on the description of the group and select DIAGNOSIS CODES 2. Select Manual Entry 3. Enter the ICD9 codes in the code field and use your tab key twice to move to the next line. Continue to enter all the codes 4. Select update to complete To delete a code highlight the line by clicking on the gray box on the far left of the 1 st column and click the delete key. When using your Template from the superbill the ICD9 code, you will now show your mapped entries available for quick selection onto your superbill. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 14 of 28

Changes to Superbill Posting: To accommodate the additional requirements of ICD10 posting and the need to continue to post both ICD9 and ICD10 into the future, changes have been made to your Superbill Posting process. The ICD pointers to the Diagnosis from the CPT codes will now point to a GROUP of Diagnosis codes (ICD9 and ICD10 codes). When you receive your ICD10 upgrade you will be able to post both ICD9 and ICD10 codes. Only ICD9 codes will be transferred to your PBSI Practice Management system (DOC) until October 1, 2015 visit dates. In fact, some of your insurance carriers may have exemptions that permit them to receive ICD9 codes well after the October 1, 2015 deadline. In our example below for our CPT code 99213 ICD1 points to GROUP 1 and ICD2 points to GROUP 2. Group 1 ICD9 250.41 ICD10 N18.1 ICD10 E10.22 E10.22 Note required posting of the N18.1 code Group 2 ICD9 380.01 ICD10 H61.011 Only ICD9 codes will be sent to DOC for billing until October 1, 2015. Use the pull down to view only the ICD9 codes. (this can also be set as your default) The DX description size has been increased to accommodate the more specific ICD10 code descriptions. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 15 of 28

Click on any DX description to perform maintenance functions on your DX group. o Delete your whole group o Delete an ICD9 or and ICD10 (from this group) o Add another ICD9 or ICD10 (to this group) o Change the sequence of your ICD9s or ICD10s within the group o View the notes associated with your ICD10 codes This will allow you to become familiar with the ICD9 to ICD10 relationships and special coding requirements, and do internal training to become ready for October 1, 2015. You will also have time to build your own mappings of commonly used ICD9 codes to the ICD10 codes that you know you will need to post. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 16 of 28

Problem List Modifications: Participation in the CMS incentive program and other quality reporting programs now require your patient problems to be recorded using SNOMED-CT codes. When you exchange clinical data with another party, the problem list must be coded with SNOMED-CT. The encounter diagnosis and the billing codes must be coded using ICD10 after OCTOBER 1, 2015. You will be populating your Patient Problem list by using the ADD function OR from the SUPERBILL when you flag the ICD as a CHRONIC condition. The examples below look complicated, but with some hand s on practice, you will find your best route to coding. Building your ICD9 to ICD10 mapping table and using defaults can help to reduce the steps to add a problem list entry to only a couple of clicks. (See: Building the ICD9 to ICD10 Mapping Tables) Enter your ICD9. (in some cases this will default for you depending upon where you come from. will default into the record or you will enter the ICD9. Click Custom ICD9 Map (if no Custom ICD9 Map button is displayed there is no mapped data). View and select from your pre-mapping tables: Highlight and SELECT the codes E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 17 of 28

If you have no Mapping Table entries or the Mapped entries do not apply to this problem: Selecting the ICD10 Click on the ICD10 ARROW symbol To post the GEM mapped ICD10. Click on Search ICD10 to Display the Family of codes to find your specific ICD10. Select your ICD10 code E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 18 of 28

Selecting the SNOMED CT We STRONGLY encourage you to code your Problem entry using SNOMED-CT in addition to your ICD9 and ICD10. The CMS Incentive program for the 2014 Edition requires you to code your problem list with SNOMED-CT codes to meet the Meaningful use criteria and for exchange purposes. After you have your ICD10 code: Click SNOMED w/icd10 to view The associated SNOMED choices. The SNOMED-CT list is filtered by your ICD10 o If no SNOMED codes are displayed, you may need to modify your ICD10 code to a less specific ICD10 by removing the rightmost character. o You may also search by SNOMED description Highlight and SELECT the appropriate SNOMED-CT. (see Posting SNOMED-CT codes) In this case no SNOMED codes were found for M50.31, so we set the Search to M50.3. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 19 of 28

ICD10 Default Settings in Practice File Maintenance The Practice File / ICD10 tab provides several setting to control ICD10 functions and timings. Skip Selection of ICD0 and SNOMED codes: Auto Add ICD/SNOMED to Mapping Table: ICD10 Codes to Posting: Transfer ICD9 and ICD10 codes to DOC: ICD Code Display: all, 9, 10 This affects the Problem List. If this is checked, you will not be required to enter an ICD10 or SNOMED code for each new Problem list entry. However, these codes are required for the meaningful use program for Clinical summary and Exchange. When a new combination of ICD9/ICD10/SNOMED codes are posted, do you want the system to automatically add this entry to your mapping table under that ICD9. (see Mapping Table section) When this is set, your DX search/selection screen will automatically lookup your ICD10 This will control when you start to send both ICD9 AND your ICD10 codes to DOC for billing. This can be started after your DOC system has been upgraded to the version needed for ICD10 posting. You do not have to wait until OCTOBER 1, 2015, but you MUST begin by that date This will filter the display of ICD on your superbill to ALL (both 9 and 10) or to just ICD9 or ICD10. ICD10 Date: mm/dd/yyyy This is the date after which your Superbill report, Progress Notes, Patient Summaries, and other critical documents will begin to print your ICD10 codes and descriptions instead of ICD9 codes. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 20 of 28

Posting your Diagnosis codes See Changes to Superbill Posting section for details about linking CPT codes to your new Diagnosis Groups. From your SUPERBILL screen: Click Add DX: New Indicators: The ICD10? Indicator alongside the System template names identifies templates whose items have all been mapped to ICD10 codes and that the template been approved for use by one of your administrators because the mapping has been completed and now contains your commonly used ICD10 codes. The Map? Indicator above the DX list in the center, indicates that this diagnosis code has at least one entry in the ICD9 to ICD10 mapping table. You may select Diagnosis codes from any of the sections displayed above. Highlight a template, then select a Diagnosis code from your list Click on a DX from the sections: Problem list, Family/Social History, Today s Encounter Diagnosis, Past Diagnoses E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 21 of 28

Post using ICD9s with NO Pre-mapping to ICD10: Using your existing ICD9 templates, select an ICD9 by clicking on the ICD9 code or description. The ICD9 will be automatically mapped to its ICD10 equivalent using the GEM (see General Equivalent Mapping (GEM) section) Before we click SELECT, we need to make sure we select the most specific ICD10 code that describes our condition. It may not be acceptable to use UNSPECIFIED codes. Use the Show Family button to view the family of more specific codes for this ICD10 code. View any NOTES that are indicated by clicking on the note indicator. Pay particular attention to any notes with a + symbol. You will need to post additional ICD10 codes. Click on a YELLOW code and click SELECT to post this ICD10 code. (you will need to delete the other additional code if you are not going to post it.) E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 22 of 28

You may get a message that your original ICD9 is being replaced by a more specific ICD9 if the ICD10 you eventually selected, no longer maps to the ICD9 that you started from. Just click OK. Your Selected Diagnosis list now contains a group of diagnosis codes. You may still perform maintenance on this group by clicking on one of the DX then clicking MAINTENANCE. The MAINTENANCE option will allow you to fix any issues you might have with your selected diagnosis. Delete the whole group and start again Delete either just the ICD9 or ICD10 Sequence the order of the ICD9 or ICD10 within the group Add an additional ICD9 or ICD10 code to this group. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 23 of 28

Your SUPERBILL now lists DX GROUP 1 with the codes you have selected. Your CPT codes will point to the DX GROUPS from your list. Click on any DX from the GROUP to access the MAINTENANCE option to make any changes to your posting. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 24 of 28

Post using ICD9 to ICD10 Mapping Table A check in the (Map?) field next to your ICD9 indicates that there is at least one mapped entry to ICD10. If you are using a template with The ICD10? box checked, the mapping of all of the ICD9s on that template has been mapped to your commonly used ICD10 codes. If no check appears here the template mapping may still be in process. Click on your ICD9. The mapped ICD10 will be displayed. Click on the Notes indicator To view them. Click the SEL box then the SELECT button to choose your ICD10. For more ICD10: Use the Show Family button to view the family of more specific codes for this ICD10 code you highlight. To post additional ICD10 codes to this Group. Click the ADD button to find and Add your additional codes. Click on a YELLOW code and click SELECT to post this ICD10 code. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 25 of 28

Posting Additional ICD10 codes from the NOTES instructions: (see Master ICD10 Code Book Understanding the Instructional Notations) When you view a NOTE that instructs you to post additional ICD10 codes along with your selected ICD10, you may use the COPY TO CLIPBOARD feature to help you copy and paste the ICD10 code group from the NOTE into a second search for the additional code. Click on the Note Indicator to view the notations. If any of the additional coding notes apply, o Highlight the line that contains the ICD10 code data you will need to use o Click on COPY to CLIPBOARD button. (this will save off the ICD10 code for quick searching later) o Close the Notes display box If you have selected your first ICD10 code and it is present on this screen, then from the Additional ICD10 CODES, use the ADD button to search for your second ICD10. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 26 of 28

To Add the additional code indicated by the NOTE: Click the ADD button. This will take you to the ICD10 Code book search. Use the windows CTL-V or Paste option to paste your copied ICD10 code from the clipboard into the search criteria of the ADD screen. Click Search to view your code or list of codes. If the notes give you a Range of codes or a starting group of codes, you may need to navigate through the code book here to find the correct additional code. Select the code you need You should now have multiple ICD10 codes present on your list. You will need to highlight and DELETE the unspecified code that you used to find the other codes. Click SELECT to choose the 2 remaining codes to your superbill E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 27 of 28

Batch Proof with ICD10 Your batch proof report will print both your ICD9 and ICD10 codes. This will be a great way for you to review the way your post and to verify your coding. Notice that the ICD10 codes contain the NOTES indicator flags to alert you that there are notations available for that code. The + symbol indicates that there may be additional coding required. You will be able to view those additional codes on this report or return to the superbill to attach them. If you have posted an ICD10 code that is not an acceptable billing code the code will display in RED and an Edit Message will state the error. Until OCTOBER 1, 2015 only the first 4 ICD9 codes per CPT will be sent to your practice management system for billing. You will also be alerted if the ICD10 code you have selected is NOT an acceptable Billing Code. E:\A Medical\EHR Information\EMR Enhancements By Revision\EHR 3.2\PBSI-EHR 3.2.1 Enhancement Summary.Doc Page 28 of 28